I am training to do home haemodiaylsis for my husband

[supernan56]

I am having a bit of a problem with the maths in working out how much fluid to take off, the staff are great at training but don't want to appear thick as having trouble getting to grips with it. Help please

[florence2]

Where we dialyse the dry weight is in kg. the dry weight is usually determined by blood pressure. The higher the BP the more fluid they like to remove. It takes quite a while of trial and error before you can stabilise a dry weight. If your dry weight is say 73.5 and you weigh say 74.6 at weigh in then you would need to lose 1.1kg plus usually 300mls for the flush and however much you drink whilst on the machine.

So. 74.6 at weigh in

- 73.5 dry weight

= 1.1

+ .3 for flush

+ .4 for a couple of small cups of tea

= 1.8 to be removed

hope this crude diagram helps. Don't worry you will soon get the hang of this. Getting the dry weight is the most difficult part and of course this shifts around too as life goes on. The dialysis teams are always monitoring BP so they are normally on the ball. You can also tell if BP falls too low and you feel dodgy then it can be reassessed.

[daisy64 in reply to florence2]

I get so angry how does the blood pressure determine the water?? it goes of heart rate and breathing as well. It is dangerous to take more than 1000 and hour off. So everyone that has high blood pressure is holding excess water?? My partner has high blood pressure and is on meds for it. We do home dialysis have done for 3 years and he does not take any water off he is 17 stone of muscle. They cannot differentiate between weight gain and water, its rubbish. The amount of people that crash on the machine cause too much water has been taken of is ridiculous. The unnecessary water that is taken of the more ill you become as your muscles dry up, plus you need to keep your fistula wet too. My partner has been on dialysis for 4 years and never taken of water, and he as fit as anything. At the end of the day its up to the individual but that is why I see a lot of ill patients and underweight due to the unnecessary water loss.

[supernan56]

Thanks Florence2 for your reply

[Hidden]

The fluid gain in weight between dialysis plus, approx 300 ml's for 'rinseback or washback'

Your 'dry weight' is the target. So If I weight 60 kg. My 'Target or Dry. and before dialysis I weigh 61.5 kg. that's 1.5 'gain' plus 300 ml washback. 1.8

If you add another 200 ml for a cup of tea, thats a total of 2 litres programed into the machine.

Dry weight does change, sometimes you loose weight, gain weight (body weight) and BP can be some indicator of this, as well as other symptoms, BP, swelling legs or puffiness around the eyes. Usually you can discuss this with the staff by phone and alter the dry or 'target' weight as needed.

Most people have a 'limit' of the total they will tolerate taking off fluid. For me its 1.8.. But the advantage of home heamo is you can do an extra session if you've had a bit of a wild party, or indulged to get the fluid off.

Low BP can mean dehydration, or too much fluid taken off.

[supernan56]

Thanks JMan, thanks for your reply, it seems to be sinking in.

[SPARKY1]

Hi superman, I do my own HHD and was trained by a renal technician at my unit. Working out your fluid assessment is fairly easy, your trainer should have showed you the method, as it comes on a fluid scoring sheet. the formula is you take your last 3 post dialysis blood pressures, that means (SBP/DBP) top and bottom. You then divide each result by 3, i.e., say your last 3 BP's are 126/68 128/72 137/69 divided by 3 is 130/69. There is also other information you need to factor such as whether you suffer with cramps, oedema, stability on dialysis etc. They should really have given you the Scoring sheet for fluid assessment, but I can email you a copy if you want.. I would be interested to know what renal unit or hospital you come under, maybe they don't have the fluid scoring assessment sheet. It really is important to know your dry weight to avoid cramps and fluid overload. Good luck anyway.

[supernan56]

Thanks Sparky1, thanks for your reply, we come under Kings Collage Hospital, I will ask about scoring sheet, if they don't have them I will take up your kind offer. Thanks

[Hidden]

Hi

You should find that the community nurse who visits very frequently at first will make the decision about how much fluid to take off for you. My husband is 70 and thought going onto home dialysis would be a huge thing but in fact he has settled into a routine and it all works well apart from the time being taken up. x

[poppydolly]

my unit refused at first to take into account that I was still weeing for England and kept trying to take off fluid that I did not have hence I got migranes after I came off each time